Shoulder Pain Research Articles

Preoperative management of patients with chronic moderate to severe shoulder pain to improve postoperative outcomes. A systematic review

Abstract Objectives To assess if implementing interventions to effectively manage preoperative chronic moderate to severe shoulder pain in patients undergoing rotator cuff repair (RCR) can improve shoulder surgery outcomes. Methods A systematic review was conducted following the PRISMA and SIGN guidelines. Randomized clinical trials (RCT), metanalysis, systematic revisions and cohort studies in Spanish/English, published within the last 10 years, evaluating interventions to control preoperative chronic moderate to severe shoulder pain in patients undergoing RCR and their impact in postoperative shoulder outcomes were included. Selected records were graded following the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence (OCEBML). RCT were graded using the PEDro scale. Results Twenty-nine records were included in the analysis. Evidence suggests that preoperative chronic moderate to severe shoulder pain is the strongest risk factor for postoperative shoulder pain (OCEBML III). Patient-related factors and shoulder pain characteristics can also influence surgery outcomes (OCEBML II/III). Predictors of better shoulder function at 2 years after surgery include higher preoperative scores on the Western Ontario Rotator Cuff index and the Constant-Murley score in the contralateral shoulder (OCEBML III). Preoperative analgesia to control shoulder pain can improve postoperative pain (OCEBML I). Preoperative patient teaching and intensive postoperative follow-up also improve pain intensity and function (OCEBML II). Discussion Preoperative chronic shoulder pain together with patient-related factors are significant predictors of postoperative shoulder outcomes, emphasizing the need for proactive pain assessment and tailored therapeutic programs.

Does Leptin and Insulin Levels Influence Pain and Disability in Subjects With Frozen Shoulder? A Cross-Sectional Study.

To investigate the relationship between leptin levels, insulin resistance (measured by HOMA), and clinical outcomes related to pain, disability, and shoulder range of motion (ROM) in patients with frozen shoulder (FS). This cross-sectional study included 34 patients diagnosed with FS. Leptin and HOMA levels were measured and analysed in relation to pain and disability scores, as assessed by the Shoulder Pain and Disability Index (SPADI), along with shoulder ROM (flexion, extension, abduction, adduction, and internal/external rotation). Linear regression models were used to evaluate associations between leptin, HOMA, and clinical outcomes, adjusting for potential confounders such as age and sex. Higher leptin levels were significantly associated with increased SPADI pain (R2 = 0.114, β = 0.397, p = 0.005) and disability scores (R2 = 0.110, β = 0.425, p = 0.006), as well as an inverse association with shoulder flexion (R2 = 0.074, β = -1.088, p = 0.025), indicating reduced ROM with higher leptin levels. Similarly, higher HOMA levels were associated with increased SPADI pain (R2 = 0.096, β = 1.078, p = 0.010) and disability scores (R2 = 0.081, β = 1.517, p = 0.017), as well as combined SPADI scores (R2 = 0.089, β = 2.595, p = 0.014). HOMA also showed a significant inverse relationship with shoulder flexion (R2 = 0.061, β = -2.097, p = 0.028), suggesting that insulin resistance may contribute to ROM limitations. Elevated leptin and insulin resistance levels were linked to greater pain, disability, and decreased ROM in patients with FS. These findings underscore the potential role of metabolic and inflammatory pathways in FS pathogenesis and highlight the importance of considering lifestyle interventions targeting leptin and insulin regulation as adjuncts to traditional management strategies for this condition. Elevated levels of leptin and HOMA (insulin resistance) are significantly associated with increased pain and disability in patients with frozen shoulder, as measured by SPADI scores. Higher leptin and HOMA levels are also associated with reduced range of motion, particularly in shoulder flexion. Targeting metabolic and inflammatory markers such as leptin and insulin resistance could inform new therapeutic approaches for managing frozen shoulder, with potential implications for treatment strategies in other inflammatory musculoskeletal conditions.

Effectiveness and Current Status of Icariin in the Treatment of Rotator Cuff Injury Associated with Osteoporosis.

Rotator cuff injury is a disease in which the muscle and tendon that constitute the rotator cuff are torn causing shoulder pain and limited function. Osteoporosis (OP) is a systemic metabolic bone disease characterized by decreased bone mass, destruction of bone microstructure, decreased bone strength, and increased bone fragility. Both are common musculoskeletal diseases that occur in middle-aged and elderly people, and their prevalence gradually increases with age. Clinically, rotator cuff injury and OP comorbidity are very common, especially in terms of bone metabolism. In recent years, plant natural products have gradually become a research hotspot. Icariin (ICA) is one of the naturally present active ingredients derived from the Berberaceae herb Epimedium. It has various pharmacological effects, such as anti-inflammatory, antioxidant, and anti- tumor properties, and is involved in the regulation of bone metabolism, which can play multiple therapeutic effects through a variety of proteins, receptors, and signaling pathways. Therefore, ICA, as a potential natural drug, is being gradually applied in the treatment of rotator cuff injury combined with OP, which has achieved great clinical efficacy. This study mainly discusses the pharmacological action and action mechanism of ICA in order to explore the potential of ICA to prevent and treat rotator cuff injury combined with OP and provide a theoretical basis for the subsequent clinical application of ICA.

Clinical and Ultrasound Evaluation of Hemiplegic Shoulder Pain in Stroke Patients: A Longitudinal Observational Study Starting in the First Hours After Stroke

Background and Objectives: Hemiplegic shoulder pain (HSP) is a common and disabling complication in stroke patients, yet its pathogenesis remains unclear. This longitudinal study aimed to investigate the clinical and ultrasound characteristics of HSP emerging within the first 72 h (T0) post-stroke, with follow-ups at one month (T1) and three months (T2). Materials and Methods: A total of 28 stroke patients with hemiparesis were assessed for HSP. Evaluations included pain severity during passive shoulder mobilization, passive and active range of motion, muscle strength, spasticity, and functional disability. Ultrasound examinations were conducted to assess tendon disorders, bursitis, effusion, glenohumeral subluxation, and adhesive capsulitis. Results: HSP prevalence increased over time, affecting 11% of patients at T0, 32% at T1, and 57% at T2. Higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS), an established marker of stroke severity, were significantly associated with HSP (p < 0.05). At T2, patients with HSP exhibited greater impairment, including restricted passive and active range of movement, pronounced muscle weakness, and increased spasticity (p < 0.05). Ultrasound findings at T2 revealed that adhesive capsulitis and glenohumeral subluxation were significantly more frequent in HSP patients (p < 0.05). Adhesive capsulitis showed a significant increase from 0% at T0 to 21% at T2 (p = 0.031), while glenohumeral subluxation exhibited a non-significant rise from 4% to 21% (p = 0.063). Patients with these conditions experienced significantly greater pain progression (p < 0.001). Conclusions: These findings suggest that capsular pathology plays a key role in the development of HSP within the first three months after stroke. The results highlight the need for targeted interventions addressing glenohumeral subluxation and adhesive capsulitis to alleviate pain and improve rehabilitation outcomes.

Do Psychological Factors Explain the Persistence of Symptoms in Individuals with Rotator Cuff-related Shoulder Pain? A Prospective Cohort Study

Objective: To determine whether psychosocial factors such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with RCRSP following an education program. Methods: One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included two meetings with a physiotherapist. After 12 and 24-weeks, participants filled only pain and disability questionnaires and based on their scores, were classified as having persistent shoulder pain or as recovered. Results: A univariable modified Poisson regression showed that higher perceived stress (RRadjusted: 1.02; 95%CI: 1.01-1.04), catastrophizing (RRadjusted: 1.01; 95%CI: 1.01-1.02), symptoms of depression (RRadjusted: 1.03; 95%CI: 1.01-1.06) and anxiety (RRadjusted: 1.03; 95%CI: 1.01-1.06), along with lower resilience (RRadjusted: 0.90; 95%CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. Additionally, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RRadjusted: 0.98; 95%CI: 0.97-0.99) and 24 weeks (RRadjusted: 0.99; 95%CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RRadjusted: 0.98; 95%CI: 0.97-0.99). Discussion: This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.

Exploring the Effects of Local Steaming in the Management of Primary Frozen Shoulder: A Case Report

Frozen shoulder is one of the commonly encountered debility, associated with the significant morbidity. Extreme pain and disability are main symptom for which the treatment is sought. Despite the recent advances in the treatment modalities, the NSAIDs continue to be the most common drugs used frequently to alleviate the symptoms of the frozen shoulder, owing to their cost effectiveness. These, however, have problematic side effects on the urinary, cardiovascular, and gastrointestinal systems when taken orally. To ensure the cost effectiveness and the safety, the recent modern research has focused on the evaluation of the topical therapies. Inkibab (local steaming) is one of the ancient and efficient parental methods of the local drug delivery in the Unani system of medicine. In this case, patient presented with the complaints of extreme pain and disability for which underwent the 7 sessions of local steaming with the medicinal decoction for 1 week span. The local steam was administered to affected area for 10 minutes, ensuring direct exposure to steam while maintaining a safe distance to avoid burns and exposure. Following the local treatment, there was a notable improvement in the patient's condition, as evidenced by reductions in both the SPADI (Shoulder Pain and Disability Index) score and the Visual Analog Scale (VAS) score. ROM, SPADI score measured before and after treatment, demonstrated significant improvement in both pain and disability, while the VAS score assessed on a daily basis presented a marked reduction in pain intensity.

Assessment of the efficacy of early versus delayed mobility exercise after arthroscopic rotator cuff repair.

Rotator cuff tears were a prevalent cause of shoulder pain and impairment, often necessitating arthroscopic rotator cuff repair. The optimal timing of postoperative mobilization initiation remains a subject of debate implicating patient outcomes. Therefore, this study aimed to evaluate the effectiveness of early and delayed mobilization after arthroscopic rotator cuff repair. A total of 84 patients who underwent unilateral arthroscopic rotator cuff repair were included in the study and divided into early and delayed mobility exercise groups. Outcome measures included range of motion, shoulder strength, pain assessment, re-tear rates, return to work and pre-injury activity, as well as patient-reported outcomes at various postoperative time points. Early mobility exercise after arthroscopic rotator cuff repair led to a significantly greater recovery of range of motion at six weeks postoperatively (P < 0.05) and shoulder strength at 12 weeks postoperatively (P < 0.05), as compared to the delayed mobility exercise group. However, the early mobility exercise resulted in non-significant excess in the pain assessment at the six-month postoperative mark (P > 0.05). Additionally, there were no statistically significant differences between the two groups in several outcome measures, including re-tear rates, return to work and pre-injury activity, and long-term patient-reported outcomes at one year post-operatively (P > 0.05). Both early and delayed mobilization exercises safely improve range of motion, shoulder strength, and pain relief after arthroscopic rotator cuff repair. Early mobilization within six to 12 weeks post-surgery enhances range of motion and strength without increasing re-tear rates. Not applicable.

Восстановление нарушенных двигательных функций плечевого сустава у лиц среднего возраста с субакромиальным болевым синдромом

The purpose of the study is to demonstrate the effectiveness of the experimental methodology of physical rehabilitation aimed at restoring active flexibility in shoulder joint flexion and reducing the intensity of pain syndrome in individuals of middle age with subacromial pain syndrome. Research methods and organization: analysis and generalization of foreign scientific literature, pedagogical experiment, mathematical and statistical data processing. The developed methodology was tested in the conditions of the scientific and practical center for physical rehabilitation "Savita" based at Lesgaft National State University of Physical Education and the ANO DPO "Academy of Physical and Rehabilitation Medicine." Research results and conclusions. The reliable improvement in active flexibility and the reduction in the intensity of pain syndrome identified during the study indicate a positive impact on the recovery of motor functions in middle-aged individuals with subacromial shoulder pain syndrome.

Shoulder adhesive capsulitis; Clinical aspects and practical algorithmic approach

Shoulder adhesive capsulitis is a relatively common shoulder problem, characterized by severe pain, progressive limitation of the active and passive movements, and significant disability. It may be primary (idiopathic) or secondary (known disorders such as diabetes, thyroid disease, cardiopulmonary diseases, stroke, cervical discopathy, after surgeries, rotator cuff tendinopathy or tears, calcific tendinitis, proximal humerus fractures, shoulder surgery, or prolonged shoulder immobilization). Adhesive capsulitis may be present in four stages, i.e. painful, freezing, frozen, and thawing. The diagnosis of adhesive capsulitis is often clinical and usually, there is no need for further imaging. There is no consensus in the management of adhesive capsulitis and the most effective treatment remains unclear. However, interventions such as patient education, analgesics, injection therapies (corticosteroids, hyaluronic acid, platelet-rich plasma, ….), exercise therapy, physiotherapy modalities, acupuncture, manual therapy and mobilization techniques, nerve blocks, hydrodilation, and surgery may help the patient to shorten the course of the longstanding disease. In this review, we aimed to provide an evidence-based algorithmic approach to this problem and an illustrated exercise protocol for proper rehabilitation of the affected patients.

Targeting Caveolin-1 for enhanced rotator cuff repair: findings from single-cell RNA sequencing

Rotator cuff injury (RCI), a prevalent cause of shoulder pain and disability, often leads to significant functional impairments due to adipocyte infiltration into the damaged tissue. Caveolin-1 (Cav-1), a critical membrane protein, plays a significant role in adipocyte differentiation and lipid metabolism. This study utilized single-cell RNA sequencing (scRNA-seq) to investigate the heterogeneity of cell subpopulations in RCI tissues and assess the regulatory effects of Cav-1. The findings revealed that Cav-1 expression negatively correlates with adipogenic activity, and its modulation through exercise or targeted therapies can significantly reduce adipocyte infiltration and enhance tissue repair. Further, Cav-1 knockout and overexpression models demonstrated the protein’s impact on key genes involved in adipocyte differentiation and lipid metabolism, such as Scd1, fatty acid synthase (FASN), and peroxisome proliferator-activated receptor gamma (Pparg). Animal studies corroborated these results, showing that exercise intervention increased Cav-1 expression, decreased adipocyte infiltration, and promoted structural repair. These insights suggest that targeting Cav-1 could offer a novel therapeutic strategy for improving RCI outcomes.

Cooled Radiofrequency Ablation in Shoulder Pain: A Cohort study

Cooled Radiofrequency Ablation in Shoulder Pain: A Cohort study

Risk Factors Associated with New Onset of Shoulder Pain and Injury Among the Athletic Population: A Systematic Review of the Literature.

There is a high incidence of shoulder injuries among overhead athletes. Identifying and understanding risk factors for these injuries, particularly those that can be modified, is a necessary step towards being able to effectively develop and implement shoulder specific injury prevention programs. Therefore, the purpose of this systematic review was to identify risk factors associated with a new onset of shoulder pain and injury among the athletic population. Systematic Review. A systematic review of the literature was performed within PubMed, Embase, AMED, CINAHL, and EmCare databases. Studies were screened utilizing the following inclusion criteria; (a) athletes currently pain free or no history of pain at baseline, (b) athletes with shoulder and or arm pain originating from a musculoskeletal shoulder problem (c) risk factors captured prospectively (d) pathoanatomy and biomechanics in isolation or in addition to personal characteristics, etc. (e) reporting relative risk, odds ratios, and/or hazard ratios and (f) follow up ≥ 6 months. Due to data heterogeneity, only a descriptive data synthesis was performed. Data were extracted and underwent risk of bias assessment utilizing the Quality in Prognosis Studies (QUIPS) tool. PRISMA guidelines were utilized throughout. Nineteen papers were included. A total of four studies investigated baseball, five handball, three swimming, two tennis, two military, one cricket, one American football, and one with multiple sports, totaling 7,802 athletes. The risk of bias among the included studies was rated from moderate to low overall with no single study being identified as high risk of bias. All studies designs were a level of evidence of II except for two studies that were level III. The most significant risk factors included range of motion, reduced strength, history of local/regional musculoskeletal pain, previous injury, and training load. There are inconsistencies in how injury and pain are defined within studies. Many risk factors are easily objectifiable and modifiable which may help in developing shoulder injury mitigation strategies. Three of the five significant risk factors for injury can be identified by objective pre-screening measures. While previous pain and injury cannot be mitigated, training loads should be closely monitored and adapted according to other risk factors and the athlete's response. 2.

Effect of pulmonary recruitment maneuver and intraperitoneal bupivacaine on post-operative shoulder pain after laparoscopic cholecystectomy: A randomized comparative study

Background: Laparoscopic cholecystectomy nowadays is the preferable approach over open cholecystectomy because of early recovery and lower rate of complications. However, some undesirable effects, such as shoulder pain, which has an incidence of about 12–60% after laparoscopic cholecystectomy, can affect the early recovery of patients. Aims and Objectives: To study the efficacy of a pulmonary recruitment maneuver and intraperitoneal bupivacaine in combination for reducing shoulder pain following laparoscopic cholecystectomy. Materials and Methods: This randomized comparative study was conducted in patients undergoing elective laparoscopic cholecystectomy in a tertiary care center. A total of 46 patients were randomly assigned to two groups: group A, intraperitoneal bupivacaine instillation was done; and group B, a combination of intraperitoneal bupivacaine and a pulmonary recruitment maneuver was done. The interventions were carried out at the end of the surgery. At 1, 6, 12, 18, 24, and 48 h postoperatively, shoulder pain and abdominal were measured on a Visual Analog Scale (VAS). Results: The incidence of shoulder pain was higher in group A in comparison to group B and difference between two was statistically significant. In group A 34.78 % patients required rescue analgesia whereas in group B 13.6% patients needed rescue analgesia in postoperative period for shoulder pain. A significant difference in VAS scores for shoulder pain in the post-operative period was observed till 12 h. For abdominal pain, no significant difference in VAS scores and consumption of rescue analgesia was observed in the post-operative period. Conclusion: When intraperitoneal bupivacaine is used in conjunction with a pulmonary recruitment maneuver, shoulder pain is significantly reduced in comparison to intraperitoneal bupivacaine alone in the post-operative period after laparoscopic cholecystectomy.

Effect of Preventive Exercise Programs for Swimmer’s Shoulder Injury on Rotator Cuff Torque and Balance in Competitive Swimmers: A Randomized Controlled Trial

Background: Over the season, competitive swimmers experience a progressive imbalance in rotator cuff strength, predisposing them to a significant risk factor for a swimmer’s shoulder injury. Objectives: Verify the effectiveness of two 12-week preventive programs on the shoulder rotators’ peak torque and conventional/functional ratios. Design: A care provider- and participant-blinded, parallel, randomized controlled trial with three groups. Participants: Competitive swimmers aged 16 to 35 years with no prior clinical issues related to their shoulders. Interventions: Twice a week, over 12 weeks, the two experimental groups performed five exercises where the only difference was executing the program with weights or elastic bands, and the control group performed a sham intervention. Main outcome measures: The concentric and eccentric peak torque of the internal and external rotators of the dominant shoulder were assessed before and after the intervention using an isokinetic dynamometer Biodex System 3, at 60°/s, 120°/s, and 180°/s. Results: Among the experimental groups, only one test indicated a reduction (p ≤ 0.05) in rotator peak torque, while the control group showed a decrease (p ≤ 0.05) in five tests. Swimmers who completed the prevention programs demonstrated less imbalance in conventional/functional ratios than controls. Conclusions: Implementing a 12-week preventive program minimizes the progressive shoulder rotational imbalance over the season in competitive swimmers. Clinical Trial Registration number: NCT06552585.

Shouldering Our Way Into a More Meaningful Research Agenda for Atraumatic Shoulder Pain: A Priority Setting Study.

OBJECTIVE: To amplify the voices of people living with atraumatic shoulder pain, their relatives, and health care practitioners, and to establish research questions. DESIGN: A priority-setting study using a modified approach originally formulated by the James Lind Alliance (JLA). METHODS: The process consisted of 6 phases (initiation, consultation, collation, prioritization, validation, and reporting), and included 2 e-surveys and 2 separate virtual workshops. We included people with atraumatic shoulder pain, relatives, health care practitioners managing shoulder pain, and researchers conducting research within the field. RESULTS: Six hundred and eight people participated (n = 383 [63%] patients, n = 213 [35%] health care practitioners, and n = 12 [2%] carers). In the first survey, 297 participants submitted 1080 potential research questions, which were collated into 16 main themes and 94 subthemes and transformed into research questions. These research questions were featured in the second survey, where 290 participants prioritized the questions, resulting in a compilation of the top 25 questions. Based on discussions from 2 separate online workshops with a total of 21 participants, a top-10 list was created. CONCLUSION: In the final priority list, the 3 research questions with the highest ranking were, first, "how can we improve the translation of research into clinical practice?"; second, "how can we prevent atraumatic shoulder pain?"; and third, "who benefits from surgery, and who does not?" J Orthop Sports Phys Ther 2025;55(3):1-12. Epub 12 February 2025. doi:10.2519/jospt.2025.13059.

Geriatric hip fracture with proximal upper extremity fracture increases morbidity and mortality

Abstract Objectives: This study investigates differences in medical, surgical, and hospital-related outcomes within 30 days between patients sustaining a hip fracture with and without concomitant upper extremity fracture. Further subgroup analysis based on fracture location was also completed. Methods Design: Retrospective review. Setting: National Readmissions Database. Patient Selection Criteria: International Classification of Diseases, 10th Revision codes were used to identify patients with geriatric hip fracture with and without a concomitant upper extremity fracture. Patients were subclassified as having a shoulder girdle, humerus, forearm, or hand fracture. Outcomes: Demographics, complications, cost, and in-house mortality were recorded. Validated logistic and linear regression models were used to determine significance and odds ratios. Results: 367,007 patients sustained a hip fracture, and 19,852 had a concomitant upper extremity fracture. Aggregate data for hip fracture with any upper extremity fracture showed an increased risk of mortality, length of hospital stay, cost, and medical and surgical complications (P &lt; 0.001). There was a 41% increase in mortality across all upper extremity fractures, a 77%–83% increase in in-hospital mortality with a concomitant proximal upper extremity fracture (humerus and shoulder), and no significant change in mortality in the forearm and hand subgroup (P &lt; 0.001). Concomitant shoulder and humerus fractures had an increased risk of all-cause medical and medical complication (P &lt; 0.001). Conclusions: This study reported an increased risk of mortality, complications, and cost of geriatric hip fractures with concomitant upper extremity fracture. Subgroup analysis demonstrated that these effects were most pronounced in proximal—versus more distal—upper extremity fractures. Surgeons should be aware of these increased risks for prognostic and patient education purposes and, with future research, may consider alternate interventions, to include surgery on the concomitant proximal upper extremity injury aimed at producing a functional and weight-bearing upper extremity to help optimize postoperative recovery. Level of Evidence: Level 3.

Exercise Into Pain in Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial with 6-Month Follow-Up [Response to Letter

Exercise Into Pain in Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial with 6-Month Follow-Up [Response to Letter

SWEET AND SALTY: SWEET SYNDROME AS THE INITIAL PRESENTATION OF NEWLY DIAGNOSED ULCERATIVE COLITIS

Abstract INTRODUCTION Sweet syndrome is a rare cutaneous disorder that arises secondary to various inciting factors, including certain medications, bacterial or viral infections, autoimmune or autoinflammatory conditions, and malignancies. It is classified into three subtypes, with classical Sweet syndrome being the most common. CASE PRESENTATION A 60-year-old male with no significant medical history presented with multiple painful erythematous and pustular skin lesions persisting for two weeks, following a trip to Aruba. His symptoms began with a painful lesion on his posterior scapular region attributed to an insect bite. He sought local care where the lesion was drained and packed. Upon returning home, his PCP initiated fluoroquinolone therapy. Subsequently, the patient developed daily fevers, experienced a 5-pound weight loss, began passing bloody stools, complained of bilateral shoulder pain, and noticed the appearance of additional similar lesions across his torso and groin. CT scan revealed colitis, and the patient met SIRS criteria, prompting the initiation of IV antibiotics. Initially suspected to have a MRSA-related abscess, he was maintained on vancomycin, although uncertainty remained regarding a unifying diagnosis. Flexible sigmoidoscopy was performed, revealing severe Mayo 3 colitis and deep ulcerations in the rectum with a continuous, circumferential pattern and no sparing areas. Inflammation worsened proximally, with narrowing of the lumen observed in the upper rectum. Skin lesion biopsy revealed intraepidermal neutrophils with associated spongiosis, a dense neutrophilic infiltrate in the dermis with apoptotic debris consistent with Sweet syndrome. Given these biopsy results, antibiotics were discontinued, and the patient was started on steroids, leading to symptom improvement. The cold forceps biopsy from the colon showed severe active proctitis with ulceration, crypt disarray, and plasmacytosis, consistent with ulcerative colitis. The patient was transitioned to oral steroids and discharged with outpatient GI follow-up for the consideration of biologic therapy. DISCUSSION Current literature reports SS predominantly in middle-aged white women with colonic involvement and other EIMs, though its association with either ulcerative colitis (UC) or Crohn’s disease remains uncertain. While the temporal relationship between SS and IBD activity is not well established, it is most frequently seen during active phases of IBD. This case highlights SS as the initial presentation of IBD in an older male, manifesting prior to any gastrointestinal symptoms or other EIMs. CONCLUSION Skin lesions, though rare, can be an early sign of IBD, making prompt recognition vital for proper treatment. A biopsy is the diagnostic gold standard and should be done immediately. Heightened clinical awareness is key, as SS may appear before any GI symptoms in IBD cases. Cutaneous lesion on the back Histology Findings in Sweet Syndrome

A Review On Parinatakeriksheera Taila For Avabahuka (frozen shoulder)

Avabahuka is a disease that usually affects the amsa sandhi.1(shoulder joint)It is produced by vata dosha or vata kapha dosha. This review article explores the therapeutic efficacy of Parinatakeriksheera Tailam, an Ayurvedic herbal oil, in the management of Avabahuka2 (frozen shoulder).It is characterised by stiffness and severe pain in shoulder joint often resulting in restricted mobility and significant discomfort. The study synthesizes available literature on the formulation, preparation, and pharmacological actions of Parinatakeriksheera Tailam3 highlighting its anti-inflammatory, analgesic, and neuroprotective properties. The synergistic effects of its ingredients are discussed in relation to their ability to reduce pain, improve shoulder mobility, and enhance overall joint function. The findings suggest that Parinatakeriksheera Tailam offers a valuable alternative treatment for Avabahuka, providing a holistic and natural approach to managing shoulder pain and stiffness.

Evaluation of Internally Cooled Radiofrequency Ablation Targeting Multiple Shoulder Nerves for Chronic Shoulder Pain Relief and Function Restoration: A Prospective Study.

Shoulder pain is a prevalent musculoskeletal disorder, affecting up to 70% of adults over their lifetime. Recently radiofrequency ablation (RFA) has gained attention as a treatment for joint pain. This study aims to evaluate the efficacy of internally cooled RFA (icRFA) in alleviating shoulder pain and improving both qualitative and quantitative measures of shoulder function. Prospective cohort study. 35 patients with chronic shoulder pain who responded positively to diagnostic blocks of the suprascapular nerve (SSN), axillary nerve (AN), and lateral pectoral nerve (LPN). Patients underwent icRFA targeting SSN, AN, and LPN. Treatment response was assessed using numeric rating scale (NRS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (AROM) in flexion and abduction. Outcomes were measured at baseline, and at 1, 3, and 6 months post-cRFA. Patient characteristics were compared between responder and non-responder to cRFA treatment and correlation analyses were conducted to explore the relationship between pain relief and functional improvement. NRS pain levels significant decreased at 1 month (Adj. P < 0.0001), 3 month (Adj. P < 0.0001) and 6 month (Adj. P = 0.0002) post-icRFA, respectively. ASES score improved at 1 months (Adj. P < 0.0001), 3 month (Adj. P < 0.0001), and 6 months (Adj. P < 0.0001) post-icRFA, respectively. Flexion AROM improved at 1 months (Adj. P < 0.0001), 3 months (Adj. P < 0.0001), and 6 months (Adj. P = 0.0139) post-icRFA, respectively. Abduction AROM improved at 1 months (Adj. P < 0.0001), 3 months (Adj. P < 0.0001), and 6 months (P < 0.0001) post-RFA, respectively. cRFA targeting the SSN, AN, and LPN is a safe and effective intervention, providing significant improvements in pain, functional activities of daily living, and AROM of shoulder for at least 6 months.